VPB0614 - Coagulopathy associated with COVID-19 (CAC)

Background: The Corona Virus Disease 19 (COVID-19) characterized by pneumonia and acute respiratory distress syndrome. These patients with severe pneumonitis are at high risk of thrombotic complications, in relation to SARS-CoV-2-induced coagulopathy

Aims: The purpose of this study: 1) evaluate the haemostasis parameters during Covid-19 infection in cases admitted to intensive care; 2) Define CAC and its relationship with mortality; 3) determine differences between CAC and disseminated intravascular coagulation (DIC).

Methods: Study population: It was a monocentric prospective cohort, carried out at the Frantz Fanon University Hospital, Blida (Algeria) for a period of 3 months for patient with confirmed status or probable case according to the Algerian Note and admitted in ICU.
Score system: For CAC diagnosis suggested by T. Iba et al. We consider a CAC if the patient has at least two of the following parameters: 1) platelets counts ; 2) prothrombin time ; 3) D-dimer ; 4) presence of Macro and/or micro-thrombosis . For DIC diagnosis we used ISTH criteria.

Results: We studied haemostasis parameters in 98 patients (75 deaths and 23 survivors). Respectively 12%, 50%, 26.5% and 39.5% of patients having platelet count < 100G/L, PT < 70% , aPTT ratio >1.2 and AT < 80% with p>0.5 between the deceased and survivors. The incidence of fibrinogen > 4 g/l and FVIII Ag >150% were respectively 41.2% P=0.02, sHR=1.3 and 59.5% p=0.04. 15.1% have developed DIC (p=0.710). 52.2% with CAC P=0.035, sHR=1.77. Logistic regression assessing COVID-19 shows that CAC is an independent risk factor for mortality p= 0.045. The development of CAC exposes 6.75 higher risk of developing DIC.

Conclusion(s): Coagulopathy associated with COVID-19 is correlated to high mortality risks.
The biological and clinical results suggest that this Coagulopathy is distinct from DIC. We
have proven that fibrinogen is a key element in distinguishing CAC from DIC.